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Swiss Medical Weekly 2016The 12-lead electrocardiogram (ECG) is the most frequently used technology in clinical cardiology. It is critical for evidence-based management of patients with most... (Review)
Review
The 12-lead electrocardiogram (ECG) is the most frequently used technology in clinical cardiology. It is critical for evidence-based management of patients with most cardiovascular conditions, including patients with acute myocardial infarction, suspected chronic cardiac ischaemia, cardiac arrhythmias, heart failure and implantable cardiac devices. In contrast to many other techniques in cardiology, the ECG is simple, small, mobile, universally available and cheap, and therefore particularly attractive. Standard ECG interpretation mainly relies on direct visual assessment. The progress in biomedical computing and signal processing, and the available computational power offer fascinating new options for ECG analysis relevant to all fields of cardiology. Several digital ECG markers and advanced ECG technologies have shown promise in preliminary studies. This article reviews promising novel surface ECG technologies in three different fields. (1) For the detection of myocardial ischaemia and infarction, QRS morphology feature analysis, the analysis of high frequency QRS components (HF-QRS) and methods using vectorcardiography as well as ECG imaging are discussed. (2) For the identification and management of patients with cardiac arrhythmias, methods of advanced P-wave analysis are discussed and the concept of ECG imaging for noninvasive localisation of cardiac arrhythmias is presented. (3) For risk stratification of sudden cardiac death and the selection of patients for medical device therapy, several novel markers including an automated QRS-score for scar quantification, the QRS-T angle or the T-wave peak-to-end-interval are discussed. Despite the existing preliminary data, none of the advanced ECG markers and technologies has yet accomplished the transition into clinical practice. Further refinement of these technologies and broader validation in large unselected patient cohorts are the critical next step needed to facilitate translation of advanced ECG technologies into clinical cardiology.
Topics: Arrhythmias, Cardiac; Electrocardiography; Heart Failure; Humans; Myocardial Ischemia; Signal Processing, Computer-Assisted; Vectorcardiography
PubMed: 27124801
DOI: 10.4414/smw.2016.14303 -
BMJ (Clinical Research Ed.) Feb 2002
Review
Topics: Arrhythmias, Cardiac; Electrocardiography; Electrodes; Heart Diseases; Heart Rate; Humans
PubMed: 11850377
DOI: 10.1136/bmj.324.7334.415 -
Differential diagnosis of rSr' pattern in leads V1 -V2. Comprehensive review and proposed algorithm.Annals of Noninvasive Electrocardiology... Jan 2015One of the more frequent dilemmas in ECG interpretation is the differential diagnosis of an rSr' pattern in leads V1 -V2 . We often face this finding in asymptomatic and... (Review)
Review
One of the more frequent dilemmas in ECG interpretation is the differential diagnosis of an rSr' pattern in leads V1 -V2 . We often face this finding in asymptomatic and otherwise healthy individuals and the causes may vary from benign nonpathological variants to severe or life-threatening heart diseases, such as Brugada syndrome or arrhythmogenic right ventricular dysplasia. In other cases, a normal variant of rSr' pattern can be misinterpreted as pathological after the occurrence of certain clinical events such as cardiac arrest or syncope of unknown cause. In this review we analyze in detail all the possible conditions, both benign and pathological that may explain the presence of this electrocardiographic pattern. We also propose a simple electrocardiographic algorithm for differential diagnosis.
Topics: Algorithms; Diagnosis, Differential; Electrocardiography; Electrodes; Funnel Chest; Heart; Heart Diseases; Humans; Hyperkalemia
PubMed: 25546557
DOI: 10.1111/anec.12241 -
Circulation Research Jun 2020Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing... (Review)
Review
Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing and emerging mobile technologies have been used to successfully identify AF in a variety of clinical and community settings, and while these technologies offer great promise for revolutionizing AF detection and screening, several major barriers may impede their effectiveness. The unclear clinical significance of device-detected AF, potential challenges in integrating patient-generated data into existing healthcare systems and clinical workflows, harm resulting from potential false positives, and identifying the appropriate scope of population-based screening efforts are all potential concerns that warrant further investigation. It is crucial for stakeholders such as healthcare providers, researchers, funding agencies, insurers, and engineers to actively work together in fulfilling the tremendous potential of mobile technologies to improve AF identification and management on a population level.
Topics: Atrial Fibrillation; Computers, Handheld; Electrocardiography; Heart Rate Determination; Humans; Wearable Electronic Devices
PubMed: 32716695
DOI: 10.1161/CIRCRESAHA.119.316342 -
Current Cardiology Reports Aug 2022Wearable technology is rapidly evolving and the data that it can provide regarding an individual's health is becoming increasingly important for clinicians to consider.... (Review)
Review
PURPOSE OF REVIEW
Wearable technology is rapidly evolving and the data that it can provide regarding an individual's health is becoming increasingly important for clinicians to consider. The purpose of this review is to help inform health care providers of the benefits of smartwatch interrogation, with a focus on reviewing the various parameters and how to apply the data in a meaningful way.
RECENT FINDINGS
This review details interpretation of various parameters found commonly in newer smartwatches such as heart rate, step count, ECG, heart rate recovery (HRR), and heart rate variability (HRV), while also discussing potential pitfalls that a clinician should be aware of. Smartwatch interrogation is becoming increasingly relevant as the continuous data it provides helps health care providers make more informed decisions regarding diagnosis and treatment. For this reason, we recommend health care providers familiarize themselves with the technology and integrate it into clinical practice.
Topics: Electrocardiography; Exercise Test; Heart Rate; Humans; Wearable Electronic Devices
PubMed: 35635678
DOI: 10.1007/s11886-022-01718-0 -
Medical & Biological Engineering &... Apr 2023The inverse problem of electrocardiography or electrocardiographic imaging (ECGI) is a technique for reconstructing electrical information about cardiac surfaces from... (Review)
Review
The inverse problem of electrocardiography or electrocardiographic imaging (ECGI) is a technique for reconstructing electrical information about cardiac surfaces from noninvasive or non-contact recordings. ECGI has been used to characterize atrial and ventricular arrhythmias. Although it is a technology with years of progress, its development to characterize atrial arrhythmias is challenging. Complications can arise when trying to describe the atrial mechanisms that lead to abnormal propagation patterns, premature or tachycardic beats, and reentrant arrhythmias. This review addresses the various ECGI methodologies, regularization methods, and post-processing techniques used in the atria, as well as the context in which they are used. The current advantages and limitations of ECGI in the fields of research and clinical diagnosis of atrial arrhythmias are outlined. In addition, areas where ECGI efforts should be concentrated to address the associated unsatisfied needs from the atrial perspective are discussed.
Topics: Humans; Atrial Fibrillation; Body Surface Potential Mapping; Electrocardiography; Heart Atria; Diagnostic Imaging
PubMed: 36370321
DOI: 10.1007/s11517-022-02709-7 -
Annals of Noninvasive Electrocardiology... Mar 2018Electrocardiographic artifacts are defined as electrocardiographic alterations, not related to cardiac electrical activity. As a result of artifacts, the components of... (Review)
Review
Electrocardiographic artifacts are defined as electrocardiographic alterations, not related to cardiac electrical activity. As a result of artifacts, the components of the electrocardiogram (ECG) such as the baseline and waves can be distorted. Motion artifacts are due to shaking with rhythmic movement. Examples of motion artifacts include tremors with no evident cause, Parkinson's disease, cerebellar or intention tremor, anxiety, hyperthyroidism, multiple sclerosis, and drugs such as amphetamines, xanthines, lithium, benzodiazepines, or shivering (due to hypothermia, fever (rigor due to shaking), cardiopulmonary resuscitation by chest compression (oscillations of great amplitude) and patients who move their limbs during the test, causing sudden irregularities in the ECG baseline that may resemble premature contractions or interfere with ECG wave shapes, or other supraventricular and ventricular arrhythmias. When the skeletal muscles experience shaking, the ECG is "bombarded" by apparently random electrical activity.
Topics: Arrhythmias, Cardiac; Artifacts; Diagnostic Errors; Electrocardiography; Female; Humans; Male
PubMed: 28940924
DOI: 10.1111/anec.12494 -
International Journal of Cardiology Mar 2018Unraveling the mechanisms underlying Takotsubo (TTS) leads to question the current inclusion of the condition within the spectrum of cardiomyopathies. Indeed, the... (Review)
Review
Unraveling the mechanisms underlying Takotsubo (TTS) leads to question the current inclusion of the condition within the spectrum of cardiomyopathies. Indeed, the clinical presentation and pathophysiology of TTS clearly differ from cardiomyopathies, i.e. diseases of heart muscle unexplained by abnormal loading conditions or coronary artery disease, which cannot recover spontaneously and may cause sudden death often in minimally symptomatic individuals or result in a gradual deterioration in ventricular function and end-stage heart failure. Furthermore, the term 'cardiomyopathy' can no longer be applied when functional or morphologic abnormalities of the coronary arteries leading to acute myocardial ischemia are deemed responsible for left ventricular (LV) systolic dysfunction. After 27years of investigation, time has come to recognize that patients with TTS do suffer from severe myocardial ischemia and fulfill all criteria of acute coronary syndromes, i.e. acute chest pain, typical electrocardiographic changes, cardiac troponin rise, as well as LV wall motion abnormalities. Accordingly, we propose that TTS should be labeled as an acute 'syndrome' to be included more appropriately within the spectrum of ischemic heart disease. With regard to the term 'stress', it may imply that the catecholamine surge is essential to produce the typical transient myocardial injury. Thus, the terminology 'Takotsubo (stress) syndrome' would more accurately reflect recent advances in the pathophysiology.
Topics: Acute Coronary Syndrome; Cardiomyopathies; Electrocardiography; Humans; Myocardial Ischemia; Societies, Medical; Takotsubo Cardiomyopathy
PubMed: 29242100
DOI: 10.1016/j.ijcard.2017.12.009 -
Journal of the American Veterinary... May 2022
Topics: Animals; Electrocardiography
PubMed: 35560128
DOI: 10.2460/javma.21.05.0263 -
Journal of the American Veterinary... May 2022
Topics: Animals; Electrocardiography
PubMed: 35905173
DOI: 10.2460/javma.21.01.0012